What is the MoH doing to build our colonoscopy capacity?

By Kate Moodabe
GM, Total Healthcare PHO

So far, Māori and Pasifika have been the losers in the National Bowel Cancer Screening Programme that is being phased in gradually across the country over a nearly five-year period. The national rollout of screening, available for 60 to 74 year olds, is planned to be completed at the end of 2021 to tackle what is this country’s second biggest cancer killer.

We have known since the Waitematā DHB undertook the pilot programme in 2012 that significant numbers of Māori and Pasifika develop life-shortening rates of bowel cancer earlier than non Maori/Pasifika and at ages that fall outside these screening programme protocols. And they die from it at younger ages than other populations in New Zealand.

About 26 per cent of bowel cancers in Māori and Pasifika occur in the 50-59 age bracket, compared to about 11 per cent in non Maori/Pasifika.  This was evidenced early in the Waitematā pilot that targetted 50 to 74 year olds. Yet the Ministry of Health decided the starting age for the national programme would be 60 years.

This decision has attracted continuing outcry from the vast majority of clinicians across New Zealand.  At the beginning of 2019 the Ministry hosted a national hui for clinical leaders to debate lowering the starting age to 50 for Māori and Pasifika. The hui issued a clear call supporting such a move. It took until early this month for the Ministry to finally announce it would not be making any changes until the national rollout is concluded at the end of next year.

The Ministry went so far as to say Māori and Pasifika will be “better served by the timely delivery of a sustainable national bowel screening programme”, rather than compromising a national roll-out by “asking more of the system than it can currently deliver”.

Put more simply, the Ministry has decided the country does not have the capacity to handle more colonoscopy tests; its modelling of lowering the screening age for these vulnerable populations predicted it would create an increase of 10 per cent in testing, with a higher impact on DHBs with large Māori and Pasifika populations.

Given that we have had nearly a decade of knowledge, reconfirmed by mounting evidence, of the vulnerability of Māori and Pasifika to bowel cancer, why has the Ministry of Health not acted earlier to upskill the testing workforce?

Presently, colonoscopies are done by gastroenterologists and surgeons. New Zealand now has a nurse endoscopist training programme but it will be some time before it generates sufficient trained personnel to make any impact on the current capacity. Some DHBs around the country are said to be already struggling with their colonoscopy wait lists.

One solution would be for DHBs to contact with the private sector to expand colonoscopy provision.

At this PHO, we are putting a strong emphasis on developing and upskilling our nursing workforce. We have already designed some of our clinics to include testing rooms. 

Let’s look at some solutions to better serve Māori and Pasifika, instead of focussing on the problem.